Ethical Issues in Paediatric Practice - Part III: Issues relating to the dying process

Despite the application of robust ethical principles, complex issues in child care commonly result in ethical dilemmas with no clear answers. This is especially so in those ‘life and death’ decisions relating to continuing curative therapy or opting for palliative care. As with many situations in paediatrics, these decisions are complicated by difficulties in establishing clear prognostic outcomes both in terms of disease progression and timescales, the child's reliance on third parties, and appropriate use of resources. Great efforts are required to ensure family members are fully informed of the evolving clinical situation relating to their child, and helping them to accept the inevitability of death. Whenever possible, they should be encouraged to plan for their child's death in a manner that is most appropriate for them as an individual family. This article will explore the ethical principles which offer guidance in these situations, and strives toward: i) establishing the acceptance of death by the child and family, ii) ensuring ‘quality time’ for both family and their dying child and, iii) safeguarding the child's right to die with dignity.